scholarly journals Metastatic mucinous cystadenocarcinoma of the pancreas presenting as intractable back pain

2019 ◽  
Vol 12 (11) ◽  
pp. e230070
Author(s):  
Nicholas Pigg ◽  
James Banks ◽  
Kristina Siddall
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Vertebral Body ◽  
Primary Tumour ◽  
Mucinous Cystadenocarcinoma ◽  
Lytic Lesion ◽  
Pain Medicine ◽  
Primary Malignancy ◽  
Lymphatic Metastases ◽  
Fourth Rib

An 85-year-old woman presented to the emergency department for evaluation of gradually worsening upper back pain of 3 weeks’ duration. Her pain radiated down her right arm and was associated with right arm weakness. She reported visiting pain medicine specialists who administered steroid and lidocaine injections, which failed to improve her symptoms. Initial CT of her chest revealed a large lytic lesion within her posterior right fourth rib extending into her T4 vertebral body. The primary malignancy, a mucinous cystadenocarcinoma of the pancreas, was later found on a CT of the abdomen. The patient was also found to have multiple pulmonary, hepatic and lymphatic metastases from the pancreatic primary tumour.

scholarly journals Effect of COVID-19 on management of patients with low back pain in the emergency department

2021 ◽  
Author(s):  
Sweekriti Sharma ◽  
Adrian C. Traeger ◽  
Gustavo C. Machado ◽  
Christina Abdel Shaheed ◽  
Caitlin Jones ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Back Pain ◽  
Back Pain ◽  
Low Back

Introduction of a modified analgesic ladder in the emergency department: Effect on oxycodone use for back pain

2021 ◽  
Vol 17 (1) ◽  
pp. 55-61
Author(s):  
Jenny Ly, BPharm, GradCertPharmPrac ◽  
Cristina P. Roman, BPharm (Hons), MPP ◽  
Carl Luckhoff, MB, ChB, FACEM ◽  
Peter A. Cameron, MBBS, MD, FACEM, FCEM (Hon) ◽  
Michael J. BPharm, GradDipHospPharm, PhD, AdvPracPharm, FSHP, FISOPP ◽  
...  
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Outcome Measure ◽  
Interquartile Range ◽  
Post Intervention ◽  
Community Based ◽  
Analgesic Ladder ◽  
Multifaceted Interventions ◽  
Discharge From Hospital ◽  
Modest Reduction

Objective: The aim of this study was to assess the introduction of an analgesic ladder and targeted education on oxycodone use for patients presenting to the emergency department (ED).Design: A retrospective pre-post implementation study was conducted. Data were extracted for patients presenting from June to July 2016 (preintervention) and June to July 2017 (post-intervention).Setting: The EDs of a major metropolitan health service and an affiliated community-based hospital.Participants: Patients with back pain where nonpharmacological interventions such as mobilization and physiotherapy are recommended as the mainstay of treatment.Interventions: A modified analgesic ladder introduced in May 2017. The ladder promoted the use of simple analgesics such as paracetamol and nonsteroidal anti-inflammatory drug (NSAIDs) prior to opioids and tramadol in preference to oxycodone in selected patients.Main outcome measure(s): The proportion of patients prescribed oxycodone and total doses administered.Results: There were 107 patients pre and 107 post-intervention included in this study. After implementation of the analgesic ladder, 78 (72.9 percent) preintervention patients and 55 (51.4 percent) post-intervention patients received oxycodone in ED (p = 0.001). The median oxycodone doses administered in the ED was 14 mg (interquartile range: 5-20 mg) and 5 mg (interquartile range: 5-10 mg; p 0.001), respectively. On discharge from hospital, a prescription for oxycodone was issued for 36 (33.6 percent) patients preintervention and 26 (24.3 percent) patients post-intervention (p = 0.13). Conclusions: Among patients with back pain, implementation of a modified analgesic ladder was associated with a statistically significant but modest reduction in oxycodone prescription. Consideration of multifaceted interventions to produce major and sustained changes in opioid prescribing is required.

scholarly journals Just the Facts: Risk stratifying non-traumatic back pain for spinal epidural abscess in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 753-755
Author(s):  
Zoe Polsky ◽  
Shawn K. Dowling ◽  
W. Bradley Jacobs
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Thoracic Spinal ◽  
Life Threatening ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Whole Spine ◽  
Spinal Epidural

A 65-year-old male with a history of hypertension presents to the emergency department (ED) with new onset of non-traumatic back pain. The patient is investigated for life-threatening diagnoses and screened for “red flag symptoms,” including fever, neurologic abnormalities, bowel/bladder symptoms, and a history of injectiondrug use (IVDU). The patient is treated symptomatically and discharged home but represents to the ED three additional times, each time with new and progressive symptoms. At the time of admission, he is unable to ambulate, has perineal anesthesia, and 500 cc of urinary retention. Whole spine magnetic resonance imaging (MRI) confirms a thoracic spinal epidural abscess. This case, and many like it, prompts the questions: when should emergency physicians consider the diagnosis of a spinal epidural abscess, and what is the appropriate evaluation of these patients in the ED? (Figure 1).

scholarly journals Analysis of Factors Related to Length of Stay Time in Patients with Back Pain at Emergency Department

2017 ◽  
Vol 30 (4) ◽  
pp. 173-178
Author(s):  
Kwang Yong Choi ◽  
Byung Hak So ◽  
Hyung Min Kim ◽  
Kyung Man Cha ◽  
Won Jung Jeong
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Length Of Stay ◽  
Stay Time

scholarly journals Endplate Deficits And Posterior Wall Injury Are Predictive Of Prolonged Back Pain After Osteoporotic Vertebral Body Fracture

2021 ◽  
Author(s):  
Masatoshi Teraguchi ◽  
Mamoru Kawakami ◽  
Yoshio Enyo ◽  
Ryohei Kagotani ◽  
Yoshimasa Mera ◽  
...  
Keyword(s):  
Back Pain ◽  
Vertebral Body ◽  
Posterior Wall ◽  
Vertebral Body Fracture ◽  
Body Fracture ◽  
Wall Injury
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